Prostate Removal Causes Urinary Dysfunction in Patients the Most

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While most men who have their prostate removed to cure prostate cancer cite sexual dysfunction as the most common side effect after surgery, a University of Florida researcher has now discovered that urinary dysfunction troubles such patients most.

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Writing in the journal Urologic Nursing, the researchers have even revealed that many patients are not emotionally prepared to face such complications.

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The study findings highlight the need for health-care practitioners to educate their patients about the physical and psychological effects that the surgery may have on their everyday lives.

"The effects of this treatment are quite immediate and can lead to depression and frustration," said lead author of the study, Bryan Weber, an assistant professor in the UF College of Nursing.

"After an initial diagnosis of prostate cancer, men may be so focused on eradicating the disease that they don't realize the effects the treatment will have on their quality of life, both for them and their families," Weber added.

Given the various treatment options for prostate cancer, men who undergo radical prostatectomy may initially decide that the risk of physical dysfunction is worth the benefit of improved likelihood of survival. However, many of them do not know what to expect in the months after surgery, Weber said.

During the study, 72 men were evaluated six weeks after they underwent prostatectomy. Besides measuring participants' physical function and assessing whether they had urinary and bowel symptoms and sexual dysfunction, the researchers also evaluated measures of self-confidence, social support and uncertainty about the disease and treatment.

Most participants were white, married and employed full-time or retired, and most had some college education.

Weber said that 57 per cent of the men reported low to moderate social support, indicating that many of the topics proved embarrassing for them to discuss with others. The level of social support was significantly related to urinary problems, suggesting that men with urinary incontinence might require more support than those with more control.

"Within the first 100 days of diagnosis, men may be so distressed and so focused on curing their cancer that they don't focus on these side effects, which is what makes it imperative for health-care professionals to educate them on ways that their lives will change and how they can cope. Almost immediately after treatment, men may experience depression, awkwardness and emasculation, which will have a great effect on their quality of life," Weber said.

The researcher suggests that clinicians assess men and their support systems, identify changes in physical function that may occur as a result of treatment, and direct them to products and services designed to help them cope with the immediate effects of sexual dysfunction and urinary and bowel incontinence.

According to Weber, numerous medications aim to ease sexual dysfunction, but many men may not realize the great expense associated with these drugs or be aware of their potential side effects.

In the same way, adds Weber, a number of options for urinary incontinence exist, such as boxer shorts that are designed to hold urinary pads, lessening the embarrassment of having to wear such items.

"Education and counselling should be provided to these men to better inform and prepare patients for the physical side effects they are likely to experience postoperatively," Weber said.

"Since we know that men are less likely to rely on support groups or be more embarrassed to discuss these items with family and friends, it's even more vital for health-care professionals to stress these issues and include options for patients. Men need to be introduced to different options, make choices and regain control over their lives," Weber added.

Joyce Davison, an assistant professor at the University of British Columbia Department of Urologic Sciences, agrees that health practitioners need to remember to thoroughly discuss the consequences of treatment with patients, and information should be tailored to each individual's needs.

"Once diagnosed with prostate cancer, men vary with regard to the type and amount of information they wish to access and the degree of decision control they wish to have. It is up to health-care professionals to assess and provide information and support accordingly," Davison said.

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